My blood pressure reading at the doctor is always "borderline." How worried should I be?

More worried than the borderline label suggests, and here is why: for Black men, the cardiovascular consequences of what appears to be borderline hypertension occur earlier and are more severe than in white men at the same blood pressure level. A Black man with an office blood pressure of 138/88 is more likely to have masked hypertension (elevated readings at home, normal in the office) than a white man with the same reading, and more likely to have already begun the target organ damage, left ventricular hypertrophy, reduced GFR, retinal arteriolar changes, that makes borderline readings clinically meaningful in this population.

The practical implication: "borderline" in the office should always be followed by home blood pressure measurement, both arms, seated quietly, morning and evening, for two weeks. The 2017 ACC/AHA guidelines now specify that more intensive blood pressure targets are especially important in Black adults given the higher burden of hypertension-related complications. A home average above 130/80 in a Black man over 35 with any family history is an intervention situation, not a watchful-waiting situation. (2017 ACC/AHA Hypertension Guidelines, https://www.acc.org/)

Cardiologist's calibrated position, Solid (1) for more intensive blood pressure management targets in Black men. This is guideline-concordant.

What to do: Purchase a validated home blood pressure cuff (Omron Series 10 or equivalent), measure both arms twice daily for two weeks, and bring the log to your physician. If your home average is above 130/80, the conversation about treatment should begin.

For the full picture, read The Cardiac Inheritance.